among diabetic individuals in all communities. Differences appear, however, in the prevalence and precise meaning of the factors within each domain. For example, the nearly universal expressed belief that one has no control over diabetes seems to be directly related to the failure to take preventive actions, but lack of control appears to depend on a number of more fundamental, experiential factors, including personal and observed experience with the chronic, consistent worsening of diabetes-related dysfunction; beliefs placing causal responsibility on the larger, external culture (those who are responsible for causing it are responsible for curing it); and experienced difficulty in performing specific activities for diabetes control, such as exercise (Garro, 1995; Blanchard et al., 1999). Social barriers also play a critical role. Barriers may include pressure to eat traditional foods that are inappropriate for diabetics and lack of control over meal preparation.

Cause and Control

Diet

Foods high in fats and sugars are perceived as critical causes of obesity and diabetes, whether one is African-American (Blanchard et al., 1999; Liburd et al., 1999; Minnesota program); Hispanic (Hunt, Valenzuela, and Pugh, 1998; Zaldivar and Smolowitz, 1994); Native American, such as, Dakota Sioux (Lang, 1985, 1989) or Ojibway (Garro, 1990, 1995); or Asian American. Studies show that food-related causal beliefs differed among these communities, as did the association of such beliefs with behavior. As diabetes was absent prior to the change from traditional diets to store-bought foods, Native Americans identified it as a “whiteman’s sickness” (Garro, 1995). This focus appeared to facilitate beliefs in other “external” causes, such as hormones injected into animals and insecticides sprayed on crops. “Personal causation,” a second theme, linked diabetes to excessive drinking and overeating. Garro’s findings suggest that the externalization of the cause



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